AdviceDeath

Why Even Your Young, Broke A** Should Have a Living Will

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by Hannah Harkness

Hi there! Is the impending war giving you an increased sense of mortality? Are you aware that there were more mass shootings than days last year? Are you watching all of the coverage of climate-change induced natural disasters?

If you are, you shouldn’t need convincing to get a living will. Do you think that everything is fine and there’s no increased chance of you not living to old age? You’re wrong! But even if we agree to disagree on this, you should still get a living will. Because regardless of politics you have, what news coverage you watch, or even what shape you think the earth is, we should be able to agree you can die or come close to death at any minute.

Not everyone agrees climate change is real, but we can all agree on car accidents. And if you get injured to the point of being unable to advocate for yourself, doctors are going to want to know if you want to die comfortable or live attached to a machine. 

This may look like I’m being excessively harsh up top for clicks, but this shit is important, especially if you are young. While wills tend to be something people procrastinate on because humans seem to share a passion for avoiding thinking about death until it’s at the door, they are extremely important for young people to have because unlike the elderly, you can land yourself in a situation where you are kept alive on a machine for decades. If this isn’t something you want, please continue reading.

This article is me paying forward a harsh lesson given to me by a guest speaker at a course I took for a health science credit at West Chester University of Pennsylvania while I was an undergrad, whose name I unfortunately can’t remember. The course was called Death and Dying and I took it because I was a goth trying to fill a required elective.

One of the guest speakers was a hospice worker. This hospice worker walked in the room, handed out instructions on how to file an advance directive (legal term for living will) in Pennsylvania and then immediately pulled down the neckline of their shirt a couple of inches to show us a do not resuscitate order they had tattooed on their chest.

What followed was a long lecture of horror stories about patients being kept alive too long, having legal paperwork ignored due to hospital incompetence, or dying in the hospital when they wanted to die at home because their families wouldn’t stop arguing. This was followed by a short video on the Terry Schiavo case that brought this issue to the national spotlight during the Bush administration, and an additional video that was grisly enough that a classmate blacked out. Class was dismissed and we were turned out into the street imbued with the fear of God. 

So! How do you make sure a hospital or a medical professional does what you want if you get to death’s door?

While it might seem like paperwork is the most important part (and I will link you to those resources at the end of the article) it’s actually more important that you have frequent discussions with whoever you want to make EOL (end of life) decisions on your behalf, and with your healthcare providers.

Talking to your family about death might be more tedious than paperwork, but you need to do it, because whether or not doctors listen to paperwork is kind of a crapshoot. According to this terrifying article in the New York Times about advance directives being ignored:

 “Researchers at the University of California, Los Angeles, surveyed more than 800 seniors and found that advance directives were not available in the medical records of more than half of the subjects who said they had completed and given them to a health care provider.”

This can happen for a number of reasons ranging to documents not being transferred when you switch medical providers to an incompetent administrative assistant not putting that piece of paper in your chart.  And even if the paperwork you signed does make it into the correct hands, according to The American Bar Association (the #1 internet resource on how to die the way you want), Advance Directives are NOT legally binding. ABA’s list of myths and facts regarding advance directives states:

Advance directives are legally recognized documents and doctors must respect your known wishes, but doctors can always refuse to comply with your wishes if they have an objection of conscience or consider your wishes medically inappropriate. Then, they have an obligation to help transfer you to another health care provider who will comply. Advance directive laws give doctors and others immunity if they follow your valid advance directive. This is the “carrot” the law provides to them.The only reliable strategy is to discuss your values and wishes with your health care providers ahead of time, to make sure they are clear about what you want, are willing to support your wishes, and they document your wishes.” 

This is why conversations are the most important, as well as appointing a proxy decision maker/someone with power of attorney to advocate for you in the event of your death.

Not having this increases your chances of having a dispute amongst your family/healthcare providers on how to proceed or a court appointed guardian making this decision for you.

Advance Directive laws vary from state to state. Your best defense against a law working against you is clear communication with family members and health care providers with as much paperwork as you can get as a backup. Even a DNR tattoo isn’t a guarantee – the guest speaker from my class is not the only person to have this idea, and some people have had it ignored (don’t be too quick to take sides here, click here for an article on the side of ignoring tattoos that makes some fair points).

Now that you’ve brought the room down with whoever you talked to about your death, let’s talk paperwork! There are two kinds of ACP (advanced care planning) documents you can have: an Advanced Directive (AD) and a Physician Order for Life Sustaining Treatment (POLST).

According to the article discussing the validity of the DNR tattoos:

“ADs are legal documents that can be completed at any time in life to guide future care and/or appoint a surrogate decision maker. ADs must be completed by the person (him/herself) and require either a witness or notary, depending on the state. POLST forms are physician orders for end-of-life (EOL) care designed to be transferred among health care institutions. They are for patients who are seriously ill or frail who are near the EOL and can be completed with the assistance of a surrogate. Table 1 summarizes the differences between ADs and POLST:”

POLST documents have proven to be especially effective in states such as Oregon and West Virginia that have electronic databases of POLST documents available to all primary and emergency medical providers. A study conducted after the first two years that this system was implemented in Oregon found that only 6.4% of patients who specified they wanted comfort measures died in the hospital. 

Congratulations, you’ve made it to the end of this bummer of an article! Here’s some resources for getting your AD taken care of…

Instructions on how to fill out your AD state by state:

https://www.everplans.com/articles/state-by-state-advance-directive-forms

Info on a handy smartphone app from the American Bar Association that gives you the ability to instantly get these forms for providers (this is in PDF form, but you can also find info on the ABA’s website): 

http://www.americanbarfoundation.org/uploads/cms/documents/flyer_for_smart_phone.pdf

And a much more detailed guide from the ABA to end of life planning with a plethora of resources that includes an educational card game called “Go Wish” just in case you thought *I* was the most flippant writer on this topic

https://www.americanbar.org/content/dam/aba/administrative/law_aging/Health_Decisions_Resources.authcheckdam.pdf 

Try not to die out there, but be ready in case you do! 

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